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Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA).

Methods

Between 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re-dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella–trochlear groove distance.

Results

All clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re-dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle–trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001).

Conclusion

Both isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority.

Level of evidence

Level III.

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Availabilty of data and materials

The data used or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

No code was generated or used during the study.

Abbreviations

LPD:

Lateral patellar dislocation

TT-TG:

Tibial tubercle–trochlear groove

MPFL:

Medial patellofemoral ligament

MPFLR:

Medial patellofemoral ligament reconstruction

FA:

Femoral anteversion

TTO:

Tibial tubercle osteotomy

DDFO:

Derotational distal femoral osteotomy

BMI:

Body mass index

ROM:

Range of motion

CT:

Computer tomography

IKDC:

International Knee Documentation Committee

BPII:

Banff Patella Instability Instrument

PCL:

Posterior condylar line

PTA:

Patella tilt angle

PCA:

Patellar congruence angle

PTG:

Patella–trochlear groove

ICC:

Intraclass correlation coefficient

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Acknowledgements

The authors would like to acknowledge the Department of Imaging of our hospital for their technical supports.

Funding

The authors did not receive support from any organization for the submitted work.

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Author notes

  1. Kuo Hao and Yingzhen Niu have contributed equally and are listed as the co-first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Kuo Hao, Yingzhen Niu, Lingce Kong & Fei Wang

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Contributions

FW contributed to the conceptualization and project administration of the study. KH and YN contributed significantly to the study design, data collection and parameter measurements. LK performed patient selection and statistical analysis. The first draft of the manuscript was written by KH and YN. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fei Wang.

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The authors have no competing interests to declare that are relevant to the content of this article.

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Institutional review board approval was obtained from the ethics committee of Third Hospital of Hebei Medical University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Hao, K., Niu, Y., Kong, L. et al. Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion. Knee Surg Sports Traumatol Arthrosc 31, 2888–2896 (2023). https://doi.org/10.1007/s00167-022-07264-0

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